Individual
ALYSSA HART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
980 CLARK ST, GARDNER, MA 01440-1220
(978) 413-7622
Mailing address
980 CLARK ST, GARDNER, MA 01440-1220
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XXP986617064
BLUE CROSS BLUE SHIELD
—
Enumeration date
03/19/2018
Last updated
03/19/2018
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